Author: Richard Francois

PANCAP, in collaboration with GGD Amsterdam, hosted a transformative learning experience from March 31 to April 04, 2025, for a diverse group of regional HIV programme managers, clinicians, and civil society representatives in Amsterdam. This initiative was more than just a study tour—it was a deep dive into innovative, inclusive, and human-centered approaches to HIV service delivery.

Despite language barriers, participants were able to learn from our Dutch colleagues, who perfectly expressed themselves in English to ensure all participants understood.

From the moment the team stepped into GGD’s facilities, it was clear: innovation thrives in spaces where trust, respect, and cultural competence are embedded in every aspect of care. Whether in the STI clinic at the GGD or The Empower Centrum Gravestein, the message was consistent: people matter more than paperwork.

Participants were reminded of the benefits of integrating social determinants of health, harm reduction, and low-threshold services to reach the most marginalised groups. Services are offered with dignity and confidentiality, ensuring that all receive judgment-free support.

The concept of a ‘Stigma-Free’ environment moved from theory to practice as participants observed how GGD designed systems that empower users. Peer support is embedded throughout service delivery. Clients aren’t just recipients, they are co-creators of solutions. This approach echoed PANCAP’s ongoing advocacy for rights-based programming, where communities most affected by HIV are engaged meaningfully in decision-making processes.

The Caribbean has made significant strides in reducing new HIV infections and increasing treatment coverage. However, persistent stigma, legal barriers, and inequitable access still hinder progress. By experiencing firsthand how GGD Amsterdam centers equity in public health responses, Caribbean stakeholders were able to reimagine what’s possible.

This learning exchange challenged participants to ask bold questions: How can we simplify access to PrEP? How do we remove barriers for anyone to receive care? What would our programmes look like if everyone felt truly safe walking through our doors?

PANCAP remains committed to fostering South-South and South-North collaborations that strengthen our regional HIV response. The insights gained from this study tour will feed directly into policy dialogues, programme planning, and advocacy across our member states.

As we move toward the 2030 global targets, we are reminded that achieving health for all starts with listening, learning, and creating systems that work for everyone—regardless of language, background, or status.

A group photograph of the participants at the South-to-South Learning Exchange held at GGD Amsterdam, The Netherlands, from 31 March to 4 April 2025.

Dr. Wendy Telgt Emanuelson, Director, PCU, on a site visit during the South-to-South Learning Exchange held at GGD Amsterdam, The Netherlands from March 31 to April 4, 2025

Neumine Marshall – Empower Centrum

As part of our Learning Journey, we had the privilege of visiting Empower Centrum at Gravenstein, a public housing system located in an area with a diverse population. We received a warm welcome by Neumine and Camiel, who told us the origin story of Empower Centrum as we experienced it on our visit. It is a story of fighting for representation, of building and supporting a community, of a continuous struggle to remove barriers, and of a commitment to developing quality healthcare for the vulnerable.

Camiel Wellington – Sexologist (L) with Dr. Nikkiah Forbes (R)

We learned about Nu Niet Zwanger (Mirjam van Wees), which helps vulnerable adults make informed choices about family planning and contraception, reducing unintended pregnancies. We also explored Sense (Francine van den Heuvel), a digital platform answering sexual health questions for young persons up to age 25, providing a safe space for learning about sex in an environment they are familiar with.

We also received valuable insight from an impressive panel of members of the Trans community, including our very own Erika Castellanos (GATE) from Belize. They discussed bridging gaps between health professionals and vulnerable groups (Camiel Wellington), building chosen families (House of Bodega), addressing migrant Trans health gaps, and the importance of representation in healthcare as both providers and in decision making.

Erika Castellanos – GATE

A patient-centered approach was the common theme. While Amsterdam has many resources that Belize does not yet have available, the resounding message is that programs built with a patient-centered focus are more likely to create change and achieve success. This gives me optimism that in Belize we can improve healthcare for vulnerable communities with the infrastructure that already exists.

Khareem and Michael from House of Bodega

Medical Students

Are we doing all we can to eliminate the stigma and discrimination in the healthcare of People living with HIV (PLHIV)?

A survey of Jamaican PLHIV in 2019 showed that stigma and discrimination, whether anticipated, internalised or experienced, are present in many aspects of life. High levels of HIV stigma and discrimination were reported among key population groups in addition to that based on their status. Over one-third reported experiencing stigma and discrimination in the previous twelve months. When seeking HIV care, 10% reported experiencing stigma and discrimination. When seeking non-HIV related care, that figure rose to 26% if they disclosed their HIV status. (The People Living with HIV Stigma Index: Jamaica. March 2020)

Dr. Camiel Welling of GGD Amsterdam’s presentation on inclusive healthcare emphasized the importance of healthcare providers recognizing the differences between their patients’ needs and those of the communities they serve.  We were introduced to the academic wheel of privilege, a self-awareness tool that explores how different people might benefit from or be marginalised by societal systems. This should then remind us that the needs of the communities often differ from our own and must be recognised.

An easy flow-through STI clinic

On the second day of the Learning Journey, the team visited the STI Clinic at GGD Amsterdam. The process and flow utilised to facilitate the client was unlike any I have seen before. It begins with the client making an online appointment. Upon arrival, they either enter their information into the computer system at the first station or scan a QR code. A similar approach, involving self-scheduling and digital check-in, has been used in the US by the Louisiana Department of Health’s Open Health Care Clinic, with promising results. Once checked in, the client confirms their identity with a staff member at a second station located some distance away from the registration booth, which, from my perspective, increases client privacy. On confirming their information, asymptomatic clients are provided with a sample urine container and two swabs – one for an anal sample and one for a pharyngeal sample.

In managing chronic conditions like HIV, understanding psychological factors is crucial for patient outcomes. Using Motivational Interviewing (MI), we can transform our patient interactions in HIV care, leading to significant health improvements for patients.

What is Motivational Interviewing?

Motivational Interviewing is an evidence-based, patient-centered counseling technique that enhances an individual’s motivation to change. By empathising with patients and exploring their ambivalence, MI empowers them to take charge of their health. When used effectively, it can improve patient adherence to antiretroviral therapy (ART), encourage healthy lifestyle choices, and address the psychological barriers that may hinder access to care.

Improving Adherence

A major challenge in HIV management is ensuring adherence to ART, as inconsistent use can lead to serious health consequences. MI engages patients as active partners in their treatment, using compassionate dialogue to help them express their fears and uncertainties. By building trust and collaboration, MI motivates patients to commit to their treatment plans.

Fostering Engagement

MI creates a safe environment for patients to share their experiences, combating the stigma and shame often associated with HIV. When patients feel understood and valued, they are more likely to engage proactively in their care, thereby enhancing their commitment to improving their health.

Tackling Co-occurring Challenges

HIV commonly coexists with issues like substance use and mental health disorders. MI effectively addresses these interconnected challenges by helping patients navigate their psychological barriers and develop personalised strategies to overcome obstacles, fostering resilience and self-efficacy.

Motivational Interviewing is a promising tool that can improve and enhance HIV care. By focusing on patient motivation and the psychological aspects of living with HIV, healthcare providers can create more supportive care environments and empower patients to become active agents in their health journeys, thus inspiring them to thrive.

John D. Kennedy said, “Leadership and learning are indispensable to each other,” and leaders from CARICOM member states demonstrated this through the South-South learning experience, which was extremely productive. While we were exhausted each day, learning from the experience never exhausted the mind. Each day, we welcomed new knowledge with anticipation of how it could be applied to our realities in the Caribbean. I look forward to innovations from countries as they adapt and incorporate best practices related to PrEP into the strengthening and expansion of this high-impact HIV prevention service. I thank PANCAP and GGD Amsterdam for a highly successful learning journey and an amazing experience in Amsterdam.